Medicare AdvantageAdministrativeHigh impact
Nursing Home Participation in the Medicare Medicaid Alignment Initiative (MMAI)
Illinois Medicaid - HFS·IL · Geriatrics·Provider Notice
Effective date
Sep 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois is implementing the Medicare Medicaid Alignment Initiative (MMAI) for dual-eligible beneficiaries in nursing homes, moving them from fee-for-service to managed care organizations. This affects billing processes, prior authorization requirements, and payment structures for nursing home services in Central Illinois and Greater Chicago regions.
Action Required
By September 1, 2014: Nursing home billing teams in Central Illinois and Greater Chicago regions must establish contracts with MMAI MCOs, update billing systems to handle managed care prior authorization processes, and implement 24-hour prior approval request capabilities. Update patient eligibility verification to identify MMAI enrollees. Failure to contract with MCOs may result in patient transfers and loss of revenue.